title: Relationship of race/ethnicity with door-to-balloon time and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: findings from Get With the Guidelines-Coronary Artery Disease.
abstract: BACKGROUND
  Prior studies have described racial/ethnic disparities in door-to-balloon (DTB) time for patients undergoing primary percutaneous coronary intervention (PCI). We sought to compare DTB time between different racial/ethnic groups undergoing primary PCI for ST-elevation myocardial infarction in Get With the Guidelines (GWTG).
  
  
  OBJECTIVE
  There may be differences in D2B time associated with race/ethnicity.
  
  
  METHODS
  We identified 7445 white (n = 6365), African American (n = 568), and Hispanic (n = 512) patients undergoing primary PCI.
  
  
  RESULTS
  There were no differences in the median DTB time between white (74 minutes; intraquartile range [IQR], 54-99), African American (77 minutes; IQR, 57-100), and Hispanic (75 minutes; IQR, 56-100) (P = 0.13) patients. There were no crude differences in DTB time ≤90 minutes; however, after adjusting for confounders, African American race was associated with lower odds of DTB time ≤90 minutes (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.70-0.99; P = 0.04). This association was seen in African American males (OR: 0.66; 95% CI: 0.55-0.80) but not African American females (OR: 1.27; 95% CI: 0.96-1.68). Overall, Hispanic ethnicity was not associated with a difference in DTB time ≤90 minutes (OR: 0.98; 95% CI: 0.77-1.25; P = 0.88); although Hispanic males did have a slightly longer median DTB time compared with whites. During the study, the proportion of patients with DTB times ≤90 minutes increased for all groups, and mortality was similar between groups (white 3.8%, African American 3.0%, Hispanic 4.1%, P = 0.62).
  
  
  CONCLUSIONS
  In GWTG-Coronary Artery Disease, small differences in DTB times persist among different races/ethnicities. However, the proportion achieving DTB times ≤90 minutes has increased substantially for all patients over time, and there was no association between race/ethnicity and in-hospital mortality.
authors.affiliation: Department of Medicine, TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Cavender
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rassi
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.forename: Marie
authors.initials: M
authors.lastname: Grau-Sepulveda
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D001741:Black or African American; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D017052:Hospital Mortality / Q000208:ethnology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People